EnPHLO EMR Implementation

8/6/2019 EnPHLO EMR Implementation

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The EHR Initiative,

Meaningful Use and FederalIncentives

,he EHR Initiative

eaningful Use and $27 illion in Federal ncentives

U p d a t e s , R e q u i r e m e n t s a n d P a r t i c i p a t i o n



a n orma on ec no ogy or conom c an linical Health Act

,Signed into law on February 17 2009 as a part of the American Recovery and Reinvestment Act of 2009

“Our recovery plan will invest in electronic health

records and new technology that will, ,reduce errors bring down costs ensure

.”privacy and save lives

- , ,President Obama Address to Joint Session of Congress February 2009




ØEstablishes HIT Policy and StandardsCommittees

ØØReviews New Privacy and Security Provisions

ØØDefines Meaningful Use of EHR Systems

ØØAllocates $2 billion for the ONC

ØAllocates $27 billion in Medicare and Medicaid Incentives

Ø





eaningful Use

CMS Final Rule

Ø ,Released on July 13 2010

Ø Specifies the initial criteria EPs

must meet to qualify for federal EHR incentive payments




What is Meaningful Use?

Using certified EMR Systems to meet the:following objectives

Ø , , ,Improve quality safety efficiency and

reduce health disparitiesØEngage patients and families in their

health care

ØImprove care coordination

ØImprove population and public healthØProtect patient privacy and ensure

electronic health information security

Ø




$27 billion may be paid out to

eligible providers as incentive

payments through Medicare and Medicaid to promote the adoption and meaningful use of EHRs

ØA certified EMR system must be adopted

ØMust be deemed as an eligible provider(“ ”)EP to receive incentive payments

ØAll meaningful use requirements must be metØEligible provider must submit required

/attestations and or clinical quality reporting to CMS



ederal Incentive Facts

ØEPs must choose to participate in either;the Medicare or Medicaid incentive program

may not participate in both simultaneouslyØMay change incentive programs one time

during payment periods

ØMedicaid incentive program participants

,must select one state but may switch states annually

ØMedicaid reimbursement through individualstates

ØMedicare reimbursement through CMSØ %EPs who provide 90 or more of their

(services in inpatient or ED settings based)on POS codes are not eligible for

incentive paymentsØ



edicare Incentives

%75 of Medicare Physician Fee

-Schedule Allowed Charges Up to,$44 000 Maximum

:EPsØDoctor of Medicine or Osteopathy

ØDoctor of Dental Surgery or DentalMedicine

ØDoctor of Podiatric MedicineØDoctor of Optometry

ØChiropractor



edicare Incentives

Ø -Incentive program runs from 2011 2016

Ø2014 is the last year to begin participation

Ø EPs may receive up to five years of incentivepayments

ØEPs must adopt and meaningfully use a certified EMR System for 90 consecutive days to be eligible for

,the first incentive payment 365 consecutive days

for each incentive payment thereafterØ %Incentives are increased by 10 for EPs who

furnish services in a health professional shortagearea

Ø , %Beginning in 2015 EPs are subject to a 1 penalty

of their Medicare reimbursement increasing up to%5 for each year the EP does not demonstrate

meaningful use

Ø Medicare EPs are not eligible to receive eRx incentive payments

Ø



edicare Incentives

PaymentAmount

irst ualifies

n 2011

irst ualifies

n 2012

irst ualifies

n 2013

irst ualifies

n 2014

irst ualifies

n 2015

Payment for2011

,$18 000 $ 0 $

0 $

0 $ 0

Payment for2012

,$12 000 ,$18 000 $0

$0

$ 0

Payment for

2013

,$ 8 000 ,$12 000 ,$15 000 $

0

$ 0

Payment for2014

,$ 4 000 ,$ 8 000 ,$12 000 ,$12 000 $ 0

Payment for2015

,$ 2 000 ,$ 4 000 ,$ 8 000 ,$ 8 000 $ 0

Payment for2016

$ 0 ,$ 2 000 ,$ 4 000 ,$ 4 000 $ 0

TotalPayments

,$44 000 ,$44 000 ,$39 000 ,$24 000 $ 0



edicaid Incentives

% –Up to 85 of Allowable EMR Costs Not to,Exceed a Maximum of $63 750

%30 of EPs patient threshold must by a Medicaid recipient

:EPs

Ø ( )Physicians Pediatricians have special rules

Ø Nurse Practitioners

Ø -Certified Nurse Midwives

ØDentists

ØPhysician Assistants who provide services in a FQHC or rural health clinic led by a

Physician Assistant

•



edicaid Incentives

Ø %Pediatricians must only by a 20

Medicaid recipient threshold and therefore their incentive payments%are reduced by 33

ØØ %Pediatricians with a 30 Medicaid

threshold are eligible for the entire incentive payment amount



edicaid Incentives

Ø -Incentive program runs from 2011 2021

Ø2016 is the last year to begin participation

ØEPs may receive up to six years of incentive= , = ,payments $63 750 or $42 500 for pediatricians%who only meet a 20 Medicaid patient threshold

Ø ,EPs must adopt implement upgrade or demonstrate meaningful use of a certified EMR System to be

,eligible for the first incentive payment year demonstrate meaningful use for 90 consecutive days,for the second incentive payment year 365

consecutive days for each incentive payment thereafter

Ø , %Beginning in 2015 EPs will be subject to a 1 penalty of their Medicare reimbursement increasing%up to 5 for each year the EP does not

-demonstrate meaningful use No Medicaid reimbursement penalties applicable

ØEPs may participate in both eRx and PQRI incentiveprograms





ederal Penalty Facts

ØPenalties imposed for lack of eRx by

way of reductions in allowed Medicare physician fee schedule payments

Ø = - %2012 1

Ø = - . %2013 1 5Ø = - . %2014 and beyond 2 0

Ø

Ø

Ø




Ø Penalties imposed for lack of PQRI

reporting by way of reductions in allowed Medicare physician fee schedule payments

Ø = - . %2015 1 5

Ø = - . %2016 and beyond 2 0

ØØ

Ø




ØPenalties imposed to all providers who fail to adopt EMR by way of reductions

in allowed Medicare physician fee

:schedule paymentsØ = - %2015 1

Ø = - %2016 2

Ø = - %2017 3

Ø = - %2018 4Ø = - %2019 5

Ø

ØCMS will issue another proposed rule

to address penalties applicable to 2020 and beyond

ØNo penalties in Medicaid reimbursement for lack of EMR adoption



eaningful Use

– :Stage One Concentrates OnØCapturing electronic PHI in a structured

formatØImplementing medication management tools

ØReporting clinical quality measures and public health information

:Eligible Providers Must Complete* *See Handouts

Ø15 Core Objectives

Ø5 of 10 Menu Objectives

Ø (6 Total Clinical Quality Measures 3 core,or alternate core and 3 out of 38 from

)additional set



–nd Measures

Terminology of Objectives and Measures

Numerator- The number of patients that satisfythe objective or measure

Denominator- The total number of patients in aprovider’s patient population to whom

the objective or measure applies

Exclusion- Patient total with both a numerator and a denominator equal to zero as

none of the objective or measure

criteria apply to the patient population

Attestation- EPs attest to the truth of the dataverses electronically submitting data



Programs

Registration Requirements

ØEP’s must have an active National Provider Identification(“NPI”) number

ØEP’s must have a tax ID number or SSNØEP’s must have a web user account with the National Plan

and Provider Enumeration System (“NPPES”)

ØA NPPES user ID and password will be requiredØIf you need to create a NPPES account you mayaccess the website at:https://nppes.cms.hhs.gov./NPPES/NPIRegistryHome.do

ØIf you need to reset your ID or password or have

additional questions you may contact NPPES helpdesk at 800-465-3203 or email them at:[email protected]

https://nppes.cms.hhs.gov./NPPES/NPIRegistryHome.do

https://nppes.cms.hhs.gov./NPPES/NPIRegistryHome.do



Programs

Registration Process

ØEP’s should access the CMS Registration Portal athttps://ehrincentives.cms.gov

ØThe following websites provide complete instructions for registering for EHR Incentive Programs:

ØFor the Medicare Incentive Program:

http://www.coms.gov/EHRIncentivePrograms/Downloads/EHRMedicaidEP_Regi

ØPlease note that in order to qualify for Medicareincentives you must be enrolled in the Provider Enrollment, Chain and Ownership System (“PECOS”)

ØYou will need your NPPES ID and password toaccess the PECOS systemØFor the Medicaid Incentive

http://www.cms.gov/EHRIncentivePrograms/Downloads/EHRMedicaidEP_R

https://ehrincentives.cms.gov/

http://www.coms.gov/EHRIncentivePrograms/Downloads/EHRMedicaidEP_RegistrationUserGuide.pdf

http://www.cms.gov/EHRIncentivePrograms/Downloads/EHRMedicaidEP_RegistrationUserGuide.pdf

http://www.cms.gov/EHRIncentivePrograms/Downloads/EHRMedicaidEP_RegistrationUserGuide.pdf

http://www.coms.gov/EHRIncentivePrograms/Downloads/EHRMedicaidEP_RegistrationUserGuide.pdf

https://ehrincentives.cms.gov/



eaningful Use

CMS will continue to define meaningful

use through two more phases proposed through future rulemaking

ØPhase two objectives expected to be

released by the end of 2011ØPhase three objectives expected to be

release by the end of 2013

Ø

Ø



se

Meaningful Use Stage Timeline

2011 2012 2013 2014 2015

2011 Stage I Stage 1 Stage II Stage II TBD

2012 Stage I Stage I Stage II TBD

2013 Stage I Stage I TBD

2014 Stage I TBD

2015 TBD

FirstPaymen

tYear

CMS will continue to define meaningful use through two morephases proposed through future rulemaking



eaningful Use

Phase Two of Meaningful Use is Expected

:to Expand the Focus on

Ø Exchange of electronic PHI in

structured format between affiliate

,and unaffiliated providers facilities and EHR Systems

ØIncrease usage of computerized

provider order entryØ Expanded requirements for eRx

Ø



eaningful Use

Phase Three of Meaningful Use is

:Expected to Expand the Focus on

Ø Decision support for national high

priority conditions

Ø Patient access to self managementtools

Ø Access to comprehensive patient data

through electronic exchange of PHIØImproving population health outcomes

Ø



MR Network Solutions

Types of Network Solutions

ØSaas or ASP or HostedØØClient Server ØØHybrid

Ø

Ø

ØØØ



….uestions

F

or more information please contact- -Julie Thomas at 910 470 3971

Documents

EnPHLO EMR Implementation